Cricothyrotomy
An emergency procedure, to provide a temporary emergency airway, via the cricothyroid membrane (in the adult: 10 mm high, 22 mm wide), when there is obstruction at, or above, the larynx. Typically used in Can't Intubate, Can't Ventilate situations. An opening is made between the anterior inferior limit if the thyroid cartilage (Adam's Apple), and the anterior superior limit of the cricoid cartilage, which allows access to the airway inferior to the glottis. Care should be made to avoid the vocal cords, which lie approximately 1 cm superior to the cricothyroid membrane.

TechniqueDescription
Needle catheterA needle catheter is placed directly into the cricothyroid space.
Percutaneous dilationalSeldinger technique A guidewire is inserted through a needle or catheter. An airway catheter is then introduced over a dilator, which is threaded over the guidewire.
SurgicalAn incision is made into the cricothyroid space, then a tracheostomy or endotracheal tube is introduced. (A standard ventilation circuit, such as an Ambu bag, can be used with a Surgical Cricothyroidotomy)

Note 1: Use neck externsion, to increase exposure to cricotyroid membrane. Use a head ring, to steady the head, and place a bolster or pillows between the shoulders.

Note 2: When oxygenating through via a cricothyroid cannula, inspiration should take 1 second, and 3-4 seconds should be allowed for passive expiration.